A historical comparison of single incision and conventional multiport laparoscopic right hemicolectomy.

AIM: Single incision laparoscopic surgery (SILS) is specially suited for surgery of the right colon. This study presents the results of a historical controlled trial comparing single incision and multiport laparoscopic surgery (MLS) for right hemicolectomy. METHOD: A review of outcome data from 149 patients who underwent laparoscopic right hemicolectomy was performed from the Concord Hospital laparoscopic colorectal database. RESULTS: Between July 2006 and December 2011, 149 consecutive laparoscopic right hemicolectomies were performed. The first 74 were performed by MLS and from February 2009 all cases were performed by SILS (n = 75).The median ages in the MLS and SILS groups were 74 and 68 years. The median body mass index was 27 kg/m(2) in both groups. Patients were hospitalized for a median of 8 days in the MLS group compared with 5 days in the SILS group. The median length of the extraction wound was 50 mm in the MLS group compared with 43 mm in the SILS group. The indications for surgery were similar in both groups, being 67% and 68%. One patient in each group required conversion to open laparotomy, and no patient in the SILS group required conversion to a conventional multiport technique. Postoperative morbidity was similar in both groups. CONCLUSION: SILS offers a safe minimally invasive approach to right colon resection. In our series SILS patients had a shorter extraction wound size and shorter length of stay in hospital.

Supervised surgical training and its effect on the short-term outcome in laparoscopic colorectal surgery.

AIM: Laparoscopic colorectal surgery requires supervised training. In this paper we examine the short-term outcome following a component-based training in laparoscopic colorectal surgery. METHOD: Surgical outcome following laparoscopic colorectal resection was recorded on a prospective database. Patients were divided into three groups, including those performed by the fellows, those completed by the consultant and those completed by a combination of both. Analysis of data was carried out for all colorectal resections and the subgroup with colorectal cancer. RESULTS: 511 operations were examined between June 2006 and January 2011. There was no statistically significant difference in operating time between fellows and consultants but it was significantly longer for procedures where consultants and fellows performed components. Conversion rate, postoperative morbidity, recovery and length of stay were similar for all three groups for the whole patient cohort and also the subgroup of cancer patients. In the cancer subgroup, there was no difference in the pathological stage in the three groups. CONCLUSION: Closely supervised training in laparoscopic colorectal surgery is not associated with any adverse effect on the short-term outcome.

Standing laparoscopic-guided uterine biopsy in a southern white rhinoceros (Ceratotherium simum simum).

Transrectal ultrasonography of a 35-yr-old captive female southern white rhinoceros (Ceratotherium simum simum) with a history of chronic mucohemorrhagic vulvar discharge revealed right transmural uterine horn enlargement. Abdominal laparoscopic surgery, although extremely difficult because of inadequate instrumentation, permitted uterine visualization and biopsy. Standing anesthesia, incorporating butorphanol and azaperone together with local anesthetic infiltration, facilitated the laparoscopy. A leiomyoma was suspected on the basis of history, physical examination, ultrasonographic appearance, and histopathology. Prior rhinoceros laparoscopies have failed, primarily from limitations imposed by recumbency.

Laparoscopic partial fundoplication vs laparoscopic Nissen-Rosetti fundoplication. Short-term results of 231 cases.

BACKGROUND: Since 1992, all patients at our institution who have met standard accepted criteria for surgical intervention for complicated gastroesophageal reflux disease have been entered into a prospective sequential clinical study to evaluate outcomes of the laparoscopic approach to the Nissen-Rosetti procedure and a modified Toupet procedure. METHODS: A standardized workup with upper GI series, esophagography, and endoscopy was used in all patients. Manometry, pH testing, and other special tests were used selectively. A measuring technique was used to determine wrap size without the use of dilators. The short gastric vessels were left intact in all patients. A cosurgeon approach was used, with technical factors described herein. RESULTS: Some 226 of 231 cases were completed laparoscopically (98%)-125 patients in the Nissen-Rosetti group and 101 in the partial fundoplication group. There were no clinical failures in either group. The partial fundoplication group performed better than the Nissen-Rosetti group in all categories of comparison. Return to normal eating habits was much earlier in the partial wrap group (p < 0.0001). Postop distal esophageal sphincter pressures in the two groups were equal at 15 mmHg. Eight patients suffered significant dysphagia requiring endoscopy and dilatation, all in the Nissen-Rosetti group (p < 0.01). Minor complications occurred in 12% of the total group. There was a total surgical revision rate of 3%. There were no gastric or esophageal perforations. Average operative time was 30 min. Average hospital stay was 1.4 days. Hospital charges for the laparoscopic approach averaged $6,000 dollars compared to $12,000 for the open approach. CONCLUSION: Laparoscopic partial fundoplication is as effective as laparoscopic Nissen-Rosetti fundoplication, with a higher satisfaction rate and fewer side effects. Measuring for wrap and hiatus size eliminates the need for and risk of using stiff dilators. By utilizing cosurgeons and currently available technology, cost, operative time, hospital time, and complications can be reduced to a finite minimum.

Use of the Carden anaesthetic tube for surgery around a tracheostome.

This short communication describes the use of the Carden anaesthetic tube during surgery in and around a tracheostome. The technique, which greatly facilitates access to the operating field, is described along with it's indications and contraindications. We would like to recommend extending the use of the Carden tube to operations around a tracheostome, thereby maximizing surgical access.

Surgical reconstruction of chronic coronary band avulsions in three horses.

Three adult horses were admitted with chronic coronary band avulsions of 2-, 3-, and 46-month durations, respectively. The hoof had a typical appearance in all 3 horses, with a spur of coronary band and associated horn growing at right angles to the hoof wall. Each horse was anesthetized, and the coronary band was reconstructed. Follow-up evaluation of the 3 horses (12, 15, and 23 months after surgery, respectively), revealed healing of all 3 avulsed coronary bands. Mild roughening of the hoof wall distal to the previous avulsion site was observed.

Bone scintigraphy as an aid in the diagnosis of occult distal tarsal bone trauma in three horses.

History, physical examination, and bone scintigraphy were used to diagnose central and/or third tarsal bone trauma in 3 acutely lame horses. In all 3 cases, the results of initial radiographic examination were negative. Bone scintigraphy revealed focal, intense radioisotope uptake at the level of the distal tarsal bones in the 3 horses. Radiographs obtained 4 weeks after injury in one horse demonstrated a slab fracture of the central tarsal bone. Conservative management of the tarsal bone disease resulted in acceptable return to function in all 3 horses.